1164668687 NPI number — MAYFRANK INC

Table of content: (NPI 1164668687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164668687 NPI number — MAYFRANK INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYFRANK INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STERLING OPTICAL, IVERSON MALL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164668687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3801 BRANCH AVE STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPLE HILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20748-1415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-899-1454
Provider Business Mailing Address Fax Number:
301-702-2854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 BRANCH AVE STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE HILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20748-1415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-899-1454
Provider Business Practice Location Address Fax Number:
301-702-2854
Provider Enumeration Date:
01/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ONWUKWE
Authorized Official First Name:
DOMINIC
Authorized Official Middle Name:
SUNDAY
Authorized Official Title or Position:
PRESIDENT & CLINICAL DIRECTOR
Authorized Official Telephone Number:
240-245-4022

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TA1912 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WC0802X , with the licence number: TA1912 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , with the licence number: TA1912 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X , with the licence number: TA1912 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X , with the licence number: OP1000092 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WX0102X , with the licence number: TA1912 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 020377700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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